Endoscopic approach with recanalization and stenting is one of the methods for cicatricial tracheal stenosis. Major complications may occur if service life of stents is not observed. However, there are currently no clear timing for stenting. In world practice, there are no indications on lifelong stenting for cicatricial tracheal stenosis. Restenosis is more common after stent removal and requires repeated stenting or another treatment. In case of prolonged stenting, silicone stent should be periodically replaced with a similar one due to destruction of silicone rubber. As a rule, this maneuver is necessary after 1-3 years. Currently, there is no information about maximum allowable duration of stent without replacement and possible complications. Condition of trachea after prolonged stenting is also unknown. We present long-term (27 years) tracheal stenting with a silicone stent. Stent fragmentation and dislocation throughout this period led to respiratory failure and emergency removal. Tracheal lumen was satisfactory immediately after procedure. However, restenosis appeared after 1.5 months and required endoscopic dilation with discussion of appropriate treatment option. However, the patient refused tracheal resection with anastomosis and underwent repeated stenting with similar stent and favorable immediate result.

The objective was to evaluate the effectiveness and safety of video-assisted thoracoscopic surgery for closed chest trauma and to determine the most favorable terms for performing surgical intervention in case of complicated closed chest injury. METHODS AND MATERIALS. The study included 95 patients who underwent video-assisted thoracoscopy (VATS) for closed chest trauma. Group I – operated within the first 5 days from the moment of injury; group II – operated within 5–10 days after injury; group III – operated later than 10 days after injury. RESULTS. Performing thoracoscopic intervention within the first 5 days after the injury significantly reduces the incidence of complications such as pneumonia, pleurisy, empyema. VTS allows safely and effectively performing various surgical procedures in case of complicated closed chest trauma, and diagnosing diaphragm injuries. CONCLUSION. Indications for video-assisted thoracoscopy should be set as early as possible.

Bronchoesophageal Fistula (BEF) is an uncommon condition related to complex thoracic surgery. The development of BEF is usually an indication of the progression of bronchial or lung cancer; whereas the etiology of this illness being recorded as benign is much rarer – not exceeding 4 - 6%. [1, 2]. Surgery is the main method for treating patients who have benign BEF, allowing for the reliable result. At the same time, similar operations are extremely traumatic and are fraught with the development of post-operation complications, especially when concerning patients with genetically determined coagulopathy. Factor V Leiden mutation is a hereditary coagulopathy in which there is a point mutation in the gene that encodes blood coagulation factor V. Factor V Leiden mutation is the most common cause of the hereditary disposition to thrombosis, heart attacks, strokes in Europeans. The frequency of occurence among the population of the USA is 4 – 6% [3]. We present our own observation of successful endoscopic surgery to treat BEF in a patient with Factor V Leiden mutation and chronic pulmonary embolism.

Overall 1218 patients with lung injuries were treated during 11 years. The rate of deep wounds and injuries of central zone and root of lung was 24.9%. Endoscopic and x-ray methods (especially computed tomography) were used for diagnosis. Surgical tactics depended on type of injury. Resection of lung and pneumonectomy were performed at 10.2% patients, closure of lung wound--at 41.3%. Surgical treatment of lung wound with dissection and revision of wound canal was performed at 42.6% patients with deep injuries. Classified surgical tactics permits to reduce the rate of postoperative pulmonary complications from 62 to 11.6%, and lethality--from 11.2 to 3.1%.

We have studied NO production, ACE activity and their correlation in pleural fluid of patients with and without lung wound, in the blood serum of the wounded and blood donors. Chest wound was associated with a significant elevation of NO levels in all study groups versus controls. The greatest increase of ACE activity was observed in pleural fluid of patients with a lung wound. There was a negative correlation between NO and ACE in pleural fluid of patients with a lung wound. In all the other groups, a positive correlation between NO and ACE was revealed. ACE overactivity in the pleural fluid may be one of the factors of impaired relationship between NO and ACE in lung wound. Determination of ACE activity in the pleural fluid may serve as a diagnostic criterion of the lung injury.

The correlations between nitric oxide products (NO x ) and the angiotensin-converting enzyme (ACE) activity and malondialdehyde (MDA) were studied in the blood serum of patients with thoracic wounds (the test group) 1, 3, 7, and 14 days after the injury. The severity of a patient's state scored from 8 to 15 on the APACHE II scale. The control group comprised 20 blood donors. One day after wounding, NO x , MDA, and ACE activity significantly increased. Subsequently, NO x and ACE activity decreased, whereas MDA increased. A significant negative correlation was found between NO x and MDA, and a significant positive correlation, between NO x and ACE activity. The correlations observed in the control group were undetectable in the patients one day after wounding but were restored on the third day. Thus, thoracic injury was accompanied by an increase in NO x and MDA, which determine the severity of oxidative stress. The positive correlation between NO x and ACE activity in the control and test groups reflects their concerted action in regulating the physiological functions and metabolism.